Assessing a risk tailored intervention to prevent disabling low back pain - protocol of a cluster randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Although most patients with low back pain (LBP) recover within a few weeks a significant proportion has recurrent episodes or will develop chronic low back pain. Several mainly psychosocial risk factors for developing chronic LBP have been identified. However, effects of preventive interventions aiming at behavioural risk factors and unfavourable cognitions have yielded inconsistent results. Risk tailored interventions may provide a cost efficient and effective means to take systematic account of the individual risk factors but evidence is lacking.</p> <p>Methods/Design</p> <p>This study will be a cluster-randomised controlled trial comparing screening and a subsequent risk tailored intervention for patients with low back pain to prevent chronic low back pain compared to treatment as usual in primary care. A total of 600 patients from 20 practices in each study arm will be recruited in Berlin and Goettingen. The intervention comprises the following elements: Patients will be assigned to one of four risk groups based on a screening questionnaire. Subsequently they receive an educational intervention including information and counselling tailored to the risk group. A telephone/email consulting service for back pain related problems are offered independent of risk group assignment. The primary outcomes will be functional capacity and sick leave.</p> <p>Discussion</p> <p>This trial will evaluate the effectiveness of screening for risk factors for chronic low back pain followed by a risk tailored intervention to prevent chronic low back pain. This trial will contribute new evidence regarding the flexible use of individual physical and psychosocial risk factors in general practice.</p> <p>Trial registration</p> <p>ISRCTN 68205910</p

Formulating and Solving Sustainable Stochastic Dynamic Facility Layout Problem: A Key to Sustainable Operations

Facility layout design, a NP Hard problem, is associated with the arrangement of facilities in a manufacturing shop floor, which impacts the performance, and cost of system. Efficient design of facility layout is a key to the sustainable operations in a manufacturing shop floor. An efficient layout design not only optimizes the cost and energy due to proficient handling but also increase flexibility and easy accessibility. Traditionally, it is solved using meta-heuristic techniques. But these algorithmic or procedural methodologies do not generate effective and efficient layout design from sustainable point of view, where design should consider multiple criteria such as demand fluctuations, material handling cost, accessibility, maintenance, waste and more. In this paper, to capture the sustainability in the layout design these parameters are considered, and a new Sustainable Stochastic Dynamic Facility Layout Problem (SDFLP) is formulated and solved. SDFLP is optimized for material handling cost and rearrangement cost using various meta-heuristic techniques. The pool of layouts thus generated is then analyzed by Data Envelopment Analysis (DEA) to identify efficient layouts. A novel hierarchical methodology of consensus ranking of layouts is proposed which combines the multiple attributes/criteria. Multi Attribute decision-making (MADM) Techniques such as Technique for Order Preference by Similarity to Ideal Solution (TOPSIS), Interpretive Ranking Process (IRP) and Analytic hierarchy process (AHP), Borda-Kendall and Integer Linear Programming based rank aggregation techniques are applied. To validate the proposed methodology data sets for facility size N=12 for time period T=5 having Gaussian demand are considered

A single active catalytic site is sufficient to promote transport in P-glycoprotein

P-glycoprotein (Pgp) is an ABC transporter responsible for the ATP-dependent efflux of chemotherapeutic compounds from multidrug resistant cancer cells. Better understanding of the molecular mechanism of Pgp-mediated transport could promote rational drug design to circumvent multidrug resistance. By measuring drug binding affinity and reactivity to a conformation-sensitive antibody we show here that nucleotide binding drives Pgp from a high to a low substrate-affinity state and this switch coincides with the flip from the inward- to the outward-facing conformation. Furthermore, the outward-facing conformation survives ATP hydrolysis: the post-hydrolytic complex is stabilized by vanadate, and the slow recovery from this state requires two functional catalytic sites. The catalytically inactive double Walker A mutant is stabilized in a high substrate affinity inward-open conformation, but mutants with one intact catalytic center preserve their ability to hydrolyze ATP and to promote drug transport, suggesting that the two catalytic sites are randomly recruited for ATP hydrolysis

Influence of solution chemistry and surface condition on the critical inhibitor concentration for solutions typical of hot potassium carbonate CO2 removal plant

This research studied the influence of steel surface condition and solution chemistry on the critical inhibitor concentration required for spontaneous passivation of carbon steel in solutions typical of hot potassium carbonate plant (HPC). The inhibitor was added to the solution as V2O 5. The critical inhibitor concentration depended on solution composition and on the steel surface condition. An inhibitor concentration of 30 g/l may be required to ensure spontaneous passivation under all conditions. The spontaneous passivation of clean polished carbon steel surfaces required a critical inhibitor concentration of 0.5-1.8 g/l. A minimum level of V 5+ is required for inhibition, so that monitoring the V5+ concentration may be crucial to successfully managing corrosion protection in plant. © 2007 Springer Science+Business Media, LLC.S. J. Harjac, A. Atrens, C. J. Moss and V. Linto